PCI术后消化道出血中医药防治进展
张辰浩,孔晓琳,刘冠男,刘杰,梁春玲,李宁,张然,杨大为,刘祖发
摘要(Abstract):
本研究从中医病因病机、中医证候学特征、中医药治疗等方面对目前经皮冠状动脉介入术(PCI)术后消化道出血的中医药防治进展进行了归纳和总结,重点梳理了中药复方、中成药、单味中药等几个方面的研究情况。PCI术后消化道出血的病因病机与PCI术后脾气虚、气不摄血密切相关;中医证候多见气虚血瘀证。中药复方益气止血方和邓老冠心方具有一定临床疗效;中成药云南白药安全性较好;单味中药黄芪、大黄、三七和白及出现频率较高。临床应多利用中药多靶点干预的优势,健脾益气、活血止血是防治中医药PCI术后消化道出血的基本法则。
关键词(KeyWords): PCI;消化道出血;中医药;综述
基金项目(Foundation): 北京市科委“首都特色”专项课题(Z151100004015085)
作者(Author): 张辰浩,孔晓琳,刘冠男,刘杰,梁春玲,李宁,张然,杨大为,刘祖发
参考文献(References):
- [1]Abraham NS,Hlatky MA,Antman EM,et al.ACCF/ACG/A-HA 2010 expert consensus doucement on the concomitant use of proton pump inhibitors and thienopyridines:a focused update of the ACCF/ACG/AHA 2008 expert consensus document on reducing the gastrointestinal risks of antiplatelet therapy and NSAID use[J].Am J Gastroenterol,2010,105(12):2533-2549.
- [2]Valkhoff VE,Sturkenboom MC,Kuipers EJ.Risk factors for gastrointestinal bleeding associated with low-dose aspirin[J].Best Pract Res Clin Gastroenterol,2012,26(2):125-140.
- [3]Bhatt DL,Scheiman J,Abraham NS,et al.American college of cardiology foundation task force on clinical expert consensus documents.ACCF/ACC/AHA 2008 expert consensus document on reducing the gastrointestinal risks of antiplatelet therapy and NSAID use:a report of the American College of cardiology foundation task force on clinical expert consensus documents[J].J Am Coll Cardiol,2008,52(18):1502-1517.
- [4]Komiya R,Kamintani K,Kuho E,et al.Perioperative management and postoperative complication rates of patients on dual antiplatelet therapies after coronary drug eluting stent implantation[J].Masui,2014,63(6):629-635.
- [5]Levine GN,O'Gara PT,Bates ER,et al.2015 ACC/AHA/SCAIFocused Update on Primary Percutaneous Coronary Intervention for Patients with ST-Elevation Myocardial Infarction:an update of the 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention and the 2013 ACCF/AHAGuideline for the Management of ST-Elevation Myocardial Infarction:a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Society for Cardiovascular Angiography and Interventions[J].J Am Coll Cardiol,2015,pii:S0735-1097(15)06797-2.
- [6]Small DS,Farid NA,Payne CD,et al.Effects of the proton pump inhibitor lansoprazole on the pharmacokinetics and pharmacokinetics of prasugrel and clopidogrel[J].J Clin Pharmacol,2008,48(4):475-484.
- [7]Gutlip DE,Windecker S,Meharn R,et al.Clinical end points in coronary stent trials:a case for standardized definitions[J].Circulation,2007,115(17):2344-2351.
- [8]陈胤峰,李敏,王阶.从瘀热互结论治经皮冠状动脉介入治疗术后再狭窄炎性反应[J].中华中医药杂志,2015,30(11):3833-3836.
- [9]邱玮珑,张娜.术前综合护理干预对冠心病患者经皮冠状动脉介入术后并发症的影响[J].临床合理用药杂志,2017,10(27):157-158.
- [10]赵爱纯,褚福永,刘巍,等.早期运动联合中医综合康复对急性心肌梗死急诊经皮冠状动脉介入术后心脏功能及生活质量的影响[J].世界中西医结合杂志,2017,12(12):1695-1698.
- [11]李光辉,张军平,吕仕超,等.冠心病介入术后中医证候学研究概况[J].中华中医药学刊,2013,31(11):2404-2406.
- [12]吴焕林,罗文杰,林思松.调脾护心法治疗冠心病介入术后296例患者回顾性队列研究[J].中国现代医学杂志,2009,19(8):1220-1222.
- [13]张辰浩.冠心病支架术后消化道出血与中医证候相关性及中药预防性干预研究[D].北京:中国中医科学院,2017.
- [14]孙非非,邹澍宣.复方中药对双联抗血小板治疗冠脉综合征所致胃黏膜损伤的保护探讨[J].中西医结合心脑血管病杂志,2014,12(1):97-99.
- [15]叶雷,赵立琳,邹旭.邓老冠心方预防PCI术后抗血小板致消化道出血的研究[J].陕西中医,2014,35(3):300-301.
- [16]鲁子龙.云南白药治疗上消化道出血的临床效果观察[J].临床合理用药杂志,2016,9(8):46-47.
- [17]赵丽静,张媛,付玉.云南白药治疗上消化道出血的临床疗效[J].中国社区医师,2015,31(10):93-95.
- [18]胡敏鹂,杨小云,丁进.云南白药联合生长抑素治疗肝硬化合并上消化道大出血临床观察[J].中国中医急症,2015,26(6):1074-1076.
- [19]刘胜强,雷新军,王东琦,等.口服云南白药和凝血酶联合质子泵抑制剂治疗经皮冠脉介入术后上消化道出血的临床观察[J].心脏杂志,2012,24(4):507-509.
- [20]刘晓宁,王晓梅,宋海霞.云南白药的临床应用现状[J].中国中医急症,2009,18(9):1504-1505.
- [21]任毅,吴瑜,张敏州,等.冠心病介入治疗围术期中医证候特征及分布规律的研究[J].中西医结合心脑血管病杂志,2010,8(6):639-641.
- [22]杜健鹏.益气活血法治疗介入后冠心病的临床研究[D].北京:中国中医科学院,2010.
- [23]米红,李燕舞,王晓燕,等.黄芪总苷对脾虚大鼠胃黏膜保护机制探讨[J].中药药理与临床,2012,28(5):61-63.
- [24]张小鸿,徐先祥,汪宁卿.黄芪保护血管内皮细胞作用机制研究进展[J].中国药学杂志,2013,61(18):1526-1530.
- [25]李锐,和心依,肖燕,等.单味大黄应用治疗上消化道出血分析[J].时珍国医国药,2013,24(11):2697-2698.
- [26]贺永锋,殷鹏飞.胃镜下喷洒超微大黄粉治疗急性非静脉曲张性上消化道出血疗效观察[J].现代中西医结合杂志,2014,23(23):2574-2576.
- [27]夏鹏国,张顺仓,梁宗锁,等.三七化学成分的研究历程和概况[J].中草药,2014,45(17):2564-2570.
- [28]刘正君,吉延慧,张琪嘉珏,等.三七止血作用的实验研究[J].陕西中医学院学报,2015,38(2):71-73.
- [29]王灯节,狄留庆,康安,等.白及多糖配伍对三七总皂苷中10种成分药动学的影响[J].中草药,2017,48(4):737-746.
- [30]王亚明,郭宏伟.白及灌胃在预防中枢性应激性溃疡中的作用[J].实用心脑肺血管病杂志,2013,21(7):109.
- [31]Chin MW,Yong G,Bulsara MK,et al.Predictive and protective factors associated with upper gastrointestinal bleeding after percutaneous coronary intervention:a case-control study[J].Am J Gastroenterol,2007,102(11):2411-2416.
- [32]李剑颖,徐亚辉,庞冰洋.“治未病”理论与冠心病[J].中国中医基础医学杂志,2017,23(12):1683-1684.
- [33]叶明花,蒋力生.中医“治未病”意义阐论[J].中医杂志,2017,67(2):171-173.